Jonathan R Walker

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• Arnold, S. J., Lin, F. C., Eldersveld, J. M., Phung, M. C., Walker, J. R., & Nguyen, T. T. (2016). Seminal Vesicle Leiomyoma Mimicking Extra-prostatic Extension of Prostatic Adenocarcinoma. Urology case reports, 6, 18-20.
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  Leiomyomas are common smooth muscle neoplasms; however, leiomyomas of the seminal vesicles are extremely rare. We report a case of seminal vesicle leiomyoma in a 55-year-old African American male who underwent robot assisted laparoscopic prostatectomy (RALP) for Gleason 8 (4 + 4) adenocarcinoma. An incidental nodule arising from the left seminal vesicle was discovered during surgery, complicating the surgical dissection and suggesting extra-prostatic extension. The histologic findings in this case raised the possibility that this seminal vesicle leiomyoma may have arisen from a remnant of the mid-portion of the Müllerian duct; however, a thorough immunohistochemical (IHC) workup disproved this theory.
• Bell, R. C., Austin, E. T., Arnold, S. J., Lin, F. C., Walker, J. R., & Larsen, B. T. (2016). Rare Leiomyoma of the Tunica Dartos: A Case Report with Clinical Relevance for Malignant Transformation and HLRCC. Case reports in pathology, 2016, 6471520.
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  Background. Genital leiomyomas fall under the broader category of cutaneous leiomyomas, which are rare smooth muscle neoplasms accounting for 5% of all leiomyomas. Genital leiomyomas arising from the dartos muscle are exceedingly rare with fewer than 30 cases reported in the literature. They are typically benign and adequately treated with simple surgical excision; however, previously reported cases of malignant transformation and a possible link to the hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome warrant closer follow-up. Case Presentation. We report a case of a 47-year-old male refugee from Rwanda found to have a mobile, pea-sized, mildly painful scrotal lesion near the left penoscrotal junction and 1.5 cm indeterminate vascular mass in the right kidney. Surgical excision of the scrotal nodule was performed and the diagnosis of a dartoic leiomyoma was rendered. The presence of moderate nuclear atypia, rare mitotic activity, and close surgical margins prompted a wide reexcision. We report the surgical approach, pathologic findings, and clinical follow-up related to this scrotal lesion. Conclusion. Scrotal leiomyomas demonstrate a high rate of recurrence and pose a risk for malignant transformation. They may also indicate an underlying autosomal dominant syndrome associated with increased risk for development of an aggressive form of renal cell carcinoma. When discovered, management should include surgical excision, screening for syndromic features, and routine follow-up.
• Satyanarayan, A., Redd, L., Dyer, A., Wright, A., & Walker, J. (2015). Adenocarcinoma of the urethra with mucinous features. Reviews in urology, 17(1), 38-41.
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  Primary adenocarcinoma of the female urethra is a rare malignancy. Previous studies hypothesize multiple origins, including periurethral glands or intestinal metaplasia. We report a case of a 60-year-old white woman with adenocarcinoma of the urethra who initially presented with obstructive voiding complaints secondary to a urethral mass. Wide local excision revealed invasive adenocarcinoma of the urethra with mucinous features. There was intestinal metaplasia adjacent to the tumor, as well as separate identification of intestinal metaplasia along the urethra. Ultimately, the patient underwent radical cystectomy with ileal conduit urinary diversion with no evidence of recurrence, indicating the role of early identification and surgical intervention for such cases.